Sharon Keegan was charged with producing, possessing, and distributing child sexual abuse material after she created and shared naked images of her fourteen-year-old sister with her husband. Keegan pleaded guilty to one count but reserved the right to appeal an evidentiary ruling, arguing she acted under duress due to severe abuse by her husband. To support this defense without testifying herself, Keegan's attorney retained a forensic psychologist, Victoria Reynolds, to evaluate the impact of the alleged abuse on her legal charges. Reynolds diagnosed Keegan with a dissociative disorder and planned to testify about the abuse to explain Keegan's actions. The government moved to exclude Keegan's statements to Reynolds regarding the abuse, arguing they were inadmissible hearsay. The district court agreed, finding that Keegan's purpose in consulting Reynolds was to prepare a witness for trial rather than to obtain medical diagnosis or treatment, and excluded the statements under Rule 803(4) and Rule 403.
Circuit Judge Grant, writing for the panel, analyzed Federal Rule of Evidence 803(4), which creates a hearsay exception for statements made for and reasonably pertinent to medical diagnosis or treatment. The court emphasized that the word 'for' in the rule connotes intent and purpose. The underlying rationale for this exception is the 'selfish treatment motivation' that ensures reliability; a patient is unlikely to lie to a doctor because doing so would jeopardize their own health. The court found that Keegan's statements did not meet this standard. She consulted Reynolds after being indicted and specifically asked the expert to evaluate her experiences 'as they relate to her current legal charges.' The court noted that Keegan already had a prior diagnosis from a hospital physician who was unaware of the abuse allegations, indicating her goal was not genuine medical treatment but rather to create a witness who could tell her story to the jury. The court also addressed the 1972 Advisory Committee Note, which suggested statements made to experts for the purpose of testimony were admissible. The Eleventh Circuit declined to follow this Note, reasoning that it conflicts with the 2000 amendment to Rule 703, which explicitly limits the use of hearsay relied upon by experts to establishing the basis of their opinion, not as substantive evidence. The court concluded that allowing Keegan's statements would end-run the hearsay rules and deprive the government of the opportunity to cross-examine the actual source of the allegations.
The conviction for child pornography production stands. The decision clarifies that in the Eleventh Circuit, a defendant cannot use the medical diagnosis exception to introduce out-of-court statements of abuse to a forensic expert if the primary purpose of the consultation was litigation preparation. It reinforces the requirement that the 'selfish treatment motivation' must be genuine. The ruling leaves open the possibility that statements made to experts for genuine medical purposes will still qualify, but it narrows the scope of admissibility for forensic evaluations conducted in anticipation of trial.